Returning to the gym after bowel surgery
Why Exercise After Surgery
Movement, mobilisation out of bed, walking and exercises early in the recovery period are vitally important in the immediate post-operative period. This makes chest movements, deep breathing and coughing slightly easier and less painful in the beginning. It will also help you sit in an upright position, leading to better lung function, oxygenation and lessened swelling in the lungs or oedema. It is also very beneficial for peripheral oedema or swelling of the legs, feet and sacral area. It relieves the pressure on the buttocks and heels, which are the main pressure areas when lying in bed or sitting for any length of time.
The main benefit that it provides is it stimulates blood flow in the legs and encourages venous return to the heart. Along with that, it helps to avoid venous blood pooling in the thighs, calf and feet. The natural venous blood pumps in the calf and foot muscles are activated simply by walking. So with regular walking and exercise, your blood will keep flowing healthily and avoid getting pooled in the veins.
Simple methods by which you can minimise the risks of surgical complications have been already outlined in the help sheet entitled “How You Can Minimise the Risk of Surgical Complications”. Exercises in the weeks prior to surgery, in the immediate post-operative period and ones that can be carried out in bed from the first day are all described in a schedule: “My Schedule of Daily Bed Exercises”. This program of progressive exercises should be combined together with daily walking, which I’ve already explained in “Walking Again: Help and Advice”. With laparoscopic bowel surgery, you may be able to complete this program of exercises and daily walking within the first two weeks.
Do not get anxious or upset if you are not able to achieve this sort of progress within the same amount of time. Elderly and overweight patients along with ones who smoke or have any other underlying medical health problems may take considerably a long time to recover. Also, patients who underwent surgery for cancer may also expect to take a longer time to recover. Additionally, patients who underwent open abdominal surgery instead of a laparoscopic procedure may take on average perhaps twice as long to recover.
Once you can complete the “Bed Exercises”, “Walking Again” exercises, and you can walk more than a mile without pain or discomfort, with a balanced, even and upright style. You should then, you can start thinking about heading to the gym once again. Even if you do not normally exercise in the gym, it can be helpful for your recovery to at least try. Once you have returned to some sort of fitness, your physical and fitness recovery will be complete. It is then a separate decision you may take as to whether you continue with regular exercise or not. But remember that exercise helps and assists in regular bowel movement and it also helps avoid constipation and obesity. So, it makes sense to keep exercising regularly even after you’ve made a significant recovery.
Gym exercises should be started slowly and only once you can walk several miles without any pain or discomfort. This should not be undertaken strenuously and initially without weights as there is always the risk of producing a hernia in the weak abdominal musculature. Remember to empty your bag before start exercising. Also, the best time to exercise is early in the morning, before having anything substantial to eat as this is when the stoma is at its lest active. If the jiggling of the bag is uncomfortable a stabilising strap for the bag is available from your stoma care supplier.
I was very proud that I was able to return to the gym on the 10th postoperative day. However, remember that I was fairly fit even before the surgery. I had gone to the gym regularly prior to surgery, was not overweight, didn’t smoke, had laparoscopic surgery and had the non-cancerous benign bowel condition of diverticulitis. Despite gently returning to the gym on the 10th day, I continued with my daily bed exercises probably for three weeks. I also continued my daily three-mile walks until I was able to drive comfortably once again.
For me, it was a matter of when my lower abdominal wound was not too painful when sitting. The problem was that when I sat down, my belt buckle pressed into the wound below my umbilicus or belly button, causing significant amount of pain. I was able to alleviate this pain and help myself by changing the belt so that the buckle sat at the side rather than the front of my trousers. This proved invaluable for the first four or five weeks.
The First Visit to the Gym
Heading to the gym for the first time after the surgery, I changed at home and travelled in a tracksuit. I wore a loose pair of shorts with a wide elastic waistband. This fitted over a baggy lined thick tee-shirt. My ileostomy bag was hidden under my tee-shirt and not visible to the average punter. I changed and showered at home so there was no embarrassment. I went to the gym early in the morning before breakfast and only had a drink of fruit juice before I set out for the gym. This would minimise any action through the stoma and minimise any effluent being expressed during my exercise session. One important observation at this point is that I always emptied my bad before going to the gym.
As always, particularly, as you get older I was amazed by how quickly I had lost my fitness leading up to the surgery and after it. To outline, I was only able to undertake half of the exercises that I had been able to do only two weeks prior to the surgery. It was a struggle and disappointing at first. However, over the next week, and certainly after two weeks, my fitness was back to where it had been prior to surgery.
Static Cycling.
Initially, I warmed up with some static cycling just as I did previously. I began with gentle resistance or speed and continued at it for 10 minutes before increasing the resistance for the next 10 minutes and then again for a third 10 minutes. As I got fitter, I would start at a higher level each time. Even with my ileostomy bag on my abdomen Cycling was not a problem.
Stepper
After the cycle, I would use the stepper for 10 minutes. This had a gradual and cushioned change from one leg to the other. Consequently, it did not jiggle the ileostomy bag. As long as the transition from one leg to the other was smooth, the ileostomy was of no handicap. I started at a gentle rate, increasing the resistance but not the elevation of the climb after every 2 minutes until I had completed my 10 minutes. As my fitness improved, I started at a higher resistance.
Jogging
After a few visits to the gym, I tried jogging; slowly at first. On the first two visits, this was fine but on the next few visits, I found that the ileostomy bag had filled up a little by the time I got to jogging. The fluid in the bag would jiggle up and down as I jogged. This was uncomfortable and caused the sticky pad of the bag to drag and pull on my skin. To solve the problem, I pulled my shirt down and tucked it into my shorts, pulling the waistband of the shorts over the bottom of the bag. This helped a little. However, I found that I needed to hold the bag against my stomach with my right hand as I jogged anyway. This wasn’t too difficult to do and I was able to do my 10 minutes.
Weights Room
My routine for weightlifting was for perhaps 6 or seven exercises in the multi-gym. I did three repetitions of the maximal exercise on each piece of equipment. This did not present any problems other than that I found my right shoulder sore after the exercise. So I cut out the bench press above my head. Rachel told me that the worst thing was that I had lost all the definition and shape in my bottom or buttocks. This was very hurtful and so I added some squats with a weight bar on my shoulders. Remember any weight training or strenuous exercises should be undertaken carefully or initially without weights as there is always the risk of producing a hernia in the weak abdominal musculature. Build up very slowly as your abdominal musculature improves and returns to normal.
When I had lost almost 20 Kgs prior to the surgery, Rachel had appointed out that I now had a “saggy bottom”, which was a blow as I was told previously that this was my best characteristic. So vainly, I also added in a standing shoulder press or squat with a weight bar over my shoulders, my feet apart and pointing outwards. My squat would then strengthen my buttocks; particularly the gluteus medius and minimus muscles. The description of a “soggy bottom comes from the very popular British BBC cooking program called “The Great British Bake Off”. In the show, a “soggy bottom” is one of the worst insults competitors can get on your cake. It means that the bottom of your cake is still soggy or damp after baking. It has come to be a catchphrase and loosely translates to mean that you are no good and on the way out. A “saggy bottom” was an equivalent of that for me, so I got determines not to have one.
Once you have returned to a reasonable level of fitness, you can then make the decision as to whether to continue or not. But remember to take all the health benefits of regular exercise into account before making the decision.
Return to Driving
The usual advice about returning to driving depends on several factors. Doctors generally will only give general advice because it is the driver who has to take responsibility for any risks. Insurance companies may suggest that it depends on doctors’ advice and doctors may suggest “when you feel safe”. Generally, you may be told six weeks is a safe time to return to driving. However, several criteria must be met. Keep in mind that with laparoscopic abdominal surgery, these criteria may be met sooner than with open abdominal surgery.
Anyhow, let’s take a look at the general criteria:
- Sitting, driving, sitting and especially braking must not be inhibited by pain or any hesitation. Think: would you be able to do an emergency stop if a child ran out in front of the car you are driving?
- Are you alert, fully able to concentrate and not under the effect of any pain killer or other drugs that might make you drowsy?
- Are you able to see properly and twist around to look sideways and backwards if necessary?
- Are you able to easily get into and out of the car? There are special pads available that assist with twisting round in the seat, which consequently may help to get in and out of the car.
As far as other practical advice goes, drive for very short periods in the beginning. You can gradually build up the time. Regardless of the distance you are travelling, remember to take your ileostomy bag kit with you as you never know when disaster may strike and you make have to change the bag in a hurry.
Disclaimer: This information is only provided for general and background reading. The information should not be relied upon for treatment. The views provided are not necessarily those of the author or of the website. You should always take advice from your own general practitioner or treating specialist before a treatment is commenced or altered. In individual circumstances liability is not accepted for any reason by my-ileostomy.co.uk